Systematic Review of Patients Presenting With Suspected Myocardial Infarction and Non-Obstructive Coronary Arteries (MINOCA) | Journal Scan

Study Questions:

What are the prevalence, risk factors for, and prognosis in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA)?


A search of PubMed and Embase was performed to identify studies that included patients who had documented MI and had undergone qualitative coronary angiography. A total of 152 publications were identified as including enough clarity to identify patients with MINOCA; from this, 28 studies were used for a quantitative assessment related to clinical factors associated with MINOCA, and 46 studies were used for a qualitative assessment of pathological factors.


The prevalence of MINOCA was 6% (95% confidence interval [CI], 5-7%) with a median patient age of 55 years (95% CI, 51-59 years), and 40% women. Compared to those with MI associated with obstructive coronary artery disease (MI-CAD), the patients with MINOCA were more likely to be younger and female, but less likely to have hyperlipidemia. Other cardiovascular risk factors were similar between the two groups. All-cause mortality at 12 months was lower in MINOCA (4.7%; 95% CI, 2.6-6.9%) compared to MI-CAD (6.7%; 95% CI, 4.3-9.0%). Qualitative assessment of 46 publications evaluating the underlying pathophysiology responsible for MINOCA revealed the presence of a typical myocardial infarct on cardiac magnetic resonance imaging in only 24% of patients, with myocarditis occurring in 33% and no significant abnormality in 26%. Coronary artery spasm was inducible in 27% of MINOCA patients, and thrombophilia disorders were detected in 14%.


The authors concluded that MINOCA should be considered as a “working diagnosis” with multiple potential causes that require evaluation so that directed therapies may improve its guarded prognosis.


This review suggests that MINOCA is comprised of several etiologies. Understanding the patient and management factors related to improved long-term survival for subgroups of MINOCA will assist in the improved care for patients with MINOCA.

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Magnetic Resonance Imaging, Nuclear Imaging

Keywords: Coronary Artery Disease, Myocardial Infarction, Cardiovascular Diseases, Coronary Angiography, Hyperlipidemias, Magnetic Resonance Imaging, Myocarditis, Prevalence, Prognosis, Thrombophilia, Risk Factors

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